Stress, Anxiety, Multiple Sclerosis and Mayhem

Patient Expert

Life has been crazy lately.   I seem to be two steps behind, no matter which direction I reach.   As a result, I feel the stress and anxiety beginning to mount.   In fact, it is already mounted and is at a full gallop.   I'm being dragged behind the tallest imaginary Clydesdale horse I've ever seen.   I'm trying to find my feet.

Since the beginning of this year, life has been moving at lightning speed.   Some of it has been exhilarating, some of it has been duty-bound.   All of it has zapped my energy reserved and I'd like for it to slow down just a bit.   So many tasks accomplished, but still too many left undone with ends dangling loose.

Take writing a post, for example.   I have started many started.   I've begun research on great topics.   I've read hours of material and saved countless pdf files on my computer for future reference.   Yet, I've not been able to complete them to be shared here on HealthCentral.

Can I be straight with you?   I am underwhelmed with my ability to keep things under control lately.   I am seeing the monster called depression (usually stuck in the corner pouting because he can't be set free) grow braver and venture out of its cage to cause mischief and mayhem.   (Side note: the word mayhem makes me smile a bit.   Reminds me of the car insurance commercials with the "mayhem" character.   Love those.)

Depression is a common diagnosis in people living with MS with approximately 50 percent experiencing depression at some point in their lives.   According to a review study, one in five MS patients may be experiencing depression at any given time (Siegert and Abernethy, 2005).

More than experiencing depression lately, I have become anxious.   My anxiety levels have grown to an extent that I dug through my medicine box to find an old prescription of alprazolam (Xanax).   Although the prescription is at a very low dose, it has helped.   I have an appointment with my MS nurse practitioner next week and we will definitely discuss this further.

Anxiety and depression seem to go hand-in-hand although there are few studies examining the connection.

In a Norwegian study involving 140 MS patients, 31.4 percent of patients reported symptoms of depression and 19.3 percent reported anxiety, significant higher prevalence of both symptoms as compared to the general population (Beiske et al, 2008).   Developing MS at a younger age and fatigue were associated with symptoms of depression, while fatigue, pain, younger age at onset, and a lower disability score were associated with anxiety.   A smaller percentage of patients reported receiving treatment for depression (15.9 percent) and anxiety (11.1 percent).   As 18.2 percent of the untreated patients experiencing symptoms in this study expressed the need for treatment, it seems that there is room for improvement in the recognition and treatment of depression and anxiety in MS patients.

In an Italian study involving 95 patients living with MS, 97 patients living with chronic rheumatoid disease, and 110 healthy control subjects, it was suggested that the higher rate of depression in both patients groups (18.9 percent and 16.5 percent respectively) as compared to the control group (3.6 percent) was due to psychological reaction to the impact of disease (Zorzon et al, 2001).   However, a correlation of depression, lesion activity and brain volume changes in the brain also suggest an organic cause of depression.   Regarding anxiety, the researchers observed no significant correlation between anxiety and MRI abnormalities or disability measures in either patient group.   They basically conclude that "anxiety is a reactive response to the psychosocial pressure put on the patients."

In a previous post, we've discussed the prevalence of anxiety disorders in MS patients, while featuring data from a 2007 Canadian study.   Among 140 MS patients, 35.7 percent had been diagnosed with an anxiety disorder at some point in their lives, a higher prevalence of anxiety as compared to 23 percent seen in the general population (Korostil and Feinstein, 2007).   At the time of the study, 14 percent of patients were experiencing an active anxiety disorder.   Subjects in this study with an anxiety disorder were more likely to be female and have a history of depression, drink to excess, report higher social stress and less support, and have contemplated suicide.   A small correlation was found between reports of high levels of social stress and generalized anxiety disorder

I believe that my current anxiety is rooted in the high levels of stress I'm experiencing right now.   So much to do and so little time to do it in.   I wish that I could stop the clock for a bit simply to be able to catch up.   And hopefully, unexpected surprises such as the need to replace a crumbling sewage line under the driveway will decide to pass over our house.   We don't need our own mischievous maker of mayhem to add more stress and anxiety to the mix.

Beiske AG, Svensson E, Sandanger I, et al.   Depression and anxiety amongst multiple sclerosis patients.   Eur J Neurol.   2008 Mar;15(3):239-45.   Epub 2008 Jan 22.   doi:10.1111/j.1468-1331.2007.02041.x

Korostil M, Feinstein A.   Anxiety disorders and their clinical correlates in multiple sclerosis patients.   Mult Scler 2007 Jan;13(1):67-72.   doi:10.1177/1352458506071161

Siegert R, Abernethy D.   Depression in multiple sclerosis: a review.   J Neurol Neurosurg Psychiatry. 2005 April; 76(4): 469-475.   doi:10.1136/jnnp.2004.054635

Zorzon M, de Masi R, Nasuelli D, et al.   Depression and anxiety in multiple sclerosis. A clinical and MRI study in 95 subjects.   J Neurol. 2001 May;248(5);416-21.   doi:10.1007/s004150170184